Welk B et al, 2013: The surgical management of upper tract stone disease among spinal cord-injured patients
Welk B, Shariff S, Ordon M, Catharine Craven B, Herschorn S, Garg AX.
Division of Urology, Department of Surgery, Western University, London, Ontario, Canada
STUDY DESIGN: Retrospective cohort study, using linked, population-based health-care data.
OBJECTIVES: To describe the incidence, management and outcomes of surgically treated kidney stones after spinal cord injury (SCI). To evaluate the impact of a past history of kidney stones on the occurrence of kidney stones.
SETTING: Ontario, Canada.Methods:A total of 5121 patients were followed a median of 4 years after an incident SCI (occurring between 2002 and 2011). The primary outcome was surgical intervention for upper tract kidney stones.
RESULTS: In follow-up, 66 patients (1.3%) had 89 episodes of surgically treated kidney stones. Treatments included: ureteroscopic lithotripsy (34%), ureteral stent/percutaneous nephrostomy (30%), shockwave lithotripsy (19%) or percutaneous nephrolithotripsy (17%). Following stone treatment, the 30-day mortality rate was low, and the 30-day admission rate to an intensive care unit was 12%. A history of surgically treated kidney stones before SCI (compared with no such history) was associated with a higher risk of kidney stones after SCI (27 vs 3 per 1000 person-years; adjusted hazard ratio 14.74, 95% confidence interval 5.69-38.22).
CONCLUSIONS: During intermediate follow-up after SCI, surgically treated upper tract kidney stones occur in 1.3% of patients. Ureteroscopy with lithotripsy is the most common treatment. A history of surgically managed kidney stones before SCI portends a higher risk of stones after SCI.Spinal Cord advance online publication.
Spinal Cord. 2013 Mar 12. doi: 10.1038/sc.2013.15. [Epub ahead of print]
PMID:23478669 [PubMed - as supplied by publisher]
This is a retrospective study on 89 patients with spinal cord injuries. These patients were surgically treated because of upper urinary tract stones. A wide range of procedures were used such as stentsing, percutaneous nephrostomy, SWL, URS and PNL. It is of note that whereas a low readmission rate was recorded for patients treated with SWL, 46-100% of those treated more invasively were readmitted.
No definite conclusions can be drawn, however, because the reason for choosing a specific treatment modality was not given.